Trends in Mortality from Cirrhosis and Alcoholism --
United States, 1945-1983

Approximately 10.6 million adults in the United States can be
classified as alcoholics, and an additional 7.3 million either are
alcohol abusers or have experienced negative consequences of
alcohol
use such as arrest or involvement in an accident. In addition, an
estimated 4.6 million young people aged 14 to 17 are problem
drinkers. The public health consequences of problem drinking
include
injuries and deaths from fires, falls, drowning, homicide, suicide,
family abuse and other violence as well as industrial and motor
vehicle accidents. An estimated one-third to one-half of all
unintentionally and intentionally injured adult Americans involved
in
accidents, crimes, and suicides had been drinking alcohol (1,2).
Problem drinking also causes medical damage including pancreatitis,
nutritional deficiencies, malignancies, fetal alcohol syndrome, and
cirrhosis (the ninth leading cause of death among adults in the
United
States) (3). Recent trends in the occurrence of selected medical
complications of alcohol use are outlined below.

Since 1950, noticeable trends in selected mortality rates have
been associated with alcoholism and alcohol abuse (Table 1) (4-9).
The age-adjusted total cirrhosis death rate increased gradually
from
1950 until 1973 and has since declined. Death rates due to
alcoholism
reached a peak in 1980 and have leveled off since then.

Per capita rates of alcohol consumption rose approximately 21%
during the 1960s and 10.3% during the 1970s. Data from 1977
through
1984 (the latest year for which complete data are available) show
that
overall per capita consumption reached a plateau in 1980 and 1981
and
then declined until 1984. The 1984 consumption rate, which
approximated that of 1977, was estimated at 2.65 gallons of
absolute
ethanol per year for U.S. residents aged 14 or older.*

The trends in death rates from alcoholism and per capita
alcohol
consumption have been parallel. On the other hand, cirrhosis
mortality rates have declined since 1973, while per capita
consumption
of alcohol continued to increase until 1982.
Reported by J Colliver, PhD, D Doernberg, MLS, B Grant, PhD,
Alcohol
Epidemiologic Data System, CSR, Inc, M Dufour, MD, MPH, D
Bertolucci,
MA, Div of Biometry and Epidemiology, National Institute on Alcohol
Abuse and Alcoholism; Epidemiology Br, Div of Nutrition, Center for
Health Promotion and Education, CDC.

Editorial Note

Editorial Note: The reason for the decline in cirrhosis mortality
since 1973 is not clear--especially since deaths from alcoholism
and
per capita consumption have not shown a similar decline. Possible
reasons for this decrease include earlier diagnosis and improvement
in
medical management, which enable persons having the disease to live
longer. In addition to improved medical care, other possible
contributing factors include: changes in physicians' coding of
death
certificates, a decrease in causes of cirrhosis other than alcohol
misuse, and a decrease in co-morbid conditions with a resultant
increase in survival. If this is true, the decline in the
cirrhosis
mortality rates may not reflect changes in drinking habits of the
general population, and per capita consumption may not directly
reflect individual use patterns. Therefore, changes in the
prevalence
of chronic heavy alcohol use among certain segments of the
population
might not be seen.

Data from CDC's 1981-1983 behavioral risk factor surveys
provided
national estimates of the prevalence of three patterns of alcohol
misuse: chronic heavy alcohol use--8.7%, binge drinking--22.7%,
drinking and driving--6.1% (10,11) . The behavioral risk factor
surveillance system (12) will be used to follow secular trends in
these patterns of alcohol misuse and may provide some insight into
changes in alcohol-related mortality as reflected by death
certificate
data. Further research is needed to determine which factor(s)
account
for the decline in cirrhosis mortality.

References

Office of the Secretary. Fifth special report to the US
Congress
on alcohol and health from the Secretary of Health and Human
Services. Rockville, Maryland: Department of Health and Human
Services, 1984. DHHS publication no (ADM) 84-1291.

Colliver J, Malin H. State and national trends in
alcohol-related
mortality. Alcohol Health and Research World
1986;3(10):60-4,75.

National Center for Health Statistics. Vital statistics of the
United States: volume II (data for years 1945-1980).
Hyattsville, Maryland: National Center for Health Statistics,
(Vol I and Vol II for each year, covering the years 1945-1980).

National Center for Health Statistics. Personal communication
with Division of Vital Statistics, May 1986.

National Institute on Alcohol Abuse and Alcoholism. US alcohol
epidemiologic data reference manual, Volume 2: liver cirrhosis
mortality in the United States. Rockville, Maryland: National
Institute on Alcohol Abuse and Alcoholism, 1985.

*Estimated per capita ethanol consumption rates are based on
beverage
sales or shipments, and data include nondrinkers. Gallons of
absolute
ethanol consumption were calculated by using the following
percentages
of total beverage sales during the period 1945-1984: 1) For beer,
4.5% was used for the entire period; 2) for wine, 18.0% was used
through 1951, 17% was used for the period 1952-1968, 16.0% was used
for the period 1969-1971, 14.5% was used for the period 1972-1976,
and
12.9% was used for the period 1979-1984; and 3) for spirits, 45.0%
was
used through 1971, 43.0% was used for the period 1972-1976, and
41.1%
was used for the period 1977-1984.

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